Eyeworld

50 | EYEWORLD | MARCH 2020 R EFRACTIVE by Maxine Lipner Senior Contributing Writer stuck out is there was a statistically significant number of patients who had super vision of 20/10, and that number was significantly better than the best corrected vision preoperatively," Dr. Durrie said. While preoperatively 1% of eyes had 20/10 corrected distance visual acuity, at 3 months postop 7% had 20/10 or better uncorrected dis- tance visual acuity; by 12 months it had risen to 16%. The fact that vision continued to improve after 3 months is likely linked to a period of ad- justment where patients neuroadapt to changes in higher order aberrations, Dr. Durrie said. When excimer laser surgery first came out, the idea of super vision was overhyped, Dr. Durrie said. Though the technology has since evolved and many attain high 20/20 rates, there haven't been a lot in the 20/10 to 20/12 range, he said. "We need to keep looking at if there is something that can make us go to the next lev- el," Dr. Durrie said, adding that when patients attain acuity of 20/16 or better, they have a tendency to refer more and build the market. SMILE in the mix New refractive inroads are also being made with the more recently developed SMILE tech- nique. In a fellow eye study, investigators led by Marcus Ang, MBBS, PhD, considered how the efficacy of SMILE stacked up to femtosecond LASIK. 3 Those enrolled in the study had mod- erate to high myopia and underwent SMILE in one eye and LASIK in the other. Investigators found that SMILE attained comparable refrac- tive outcomes to LASIK. With both techniques, all patients attained 20/40 uncorrected distance visual acuity at 3 months postop; 87% of those who had LASIK attained 20/20 uncorrected distance acuity followed by 84% of SMILE recipients, Dr. Ang reported. Secondary outcomes were also promising. "The patients were quite comfortable during SMILE even though SMILE takes slightly longer," Dr. Ang said, adding, however, that they did feel a bit more uncomfortable during the lenticule extraction itself, though it wasn't significant. Early on, patients had more subjec- tive fluctuations in vision with SMILE. F rom using state-of-the-art PRK to cus- tomized LASIK treatment and beyond, EyeWorld took a look at some of the latest refractive studies. PRK myth-busting According to David TC Lin, MD, transepithelial PRK with a visual "wow" factor is possible with SmartSurf ACE (Schwind eye- tech-solutions). Most patients are able to see the clock in the room immediately postop, Dr. Lin said of the incision-less procedure. Dr. Lin and coinvestigators evaluated visual recovery with the SmartSurf ACE approach in a retrospective case series. 1 "Traditionally with PRK, many said, 'Patients cannot function for the first month until their vision improves, and there is so much pain,'" Dr. Lin said. He said these are now myths based on use of old technology. In the 1990s when laser profiles were rough, it could take a month before pa- tients reaped the benefits of PRK. Now, a more Gaussian pulse profile is smoother and allows for good immediate vision, Dr. Lin noted. The case series included 2,093 myopic eyes. Investigators found that monocularly, 62% of patients had 20/40 acuity or better immediately after surgery. When tested binocularly immedi- ately after surgery, 82% of patients had 20/32 acuity, and more than 95% were at 20/40, Dr. Lin reported. For pain management, Dr. Lin said he gives patients one drop of a topical nonsteroidal at the end of surgery and another before they leave. He finds that 99% of patients have mini- mal discomfort with this approach. Dr. Lin said the SmartSurf ACE technology is a valuable addition to refractive surgery. "I think it increases the armamentarium and removes a lot of the myths about what PRK was," Dr. Lin said. Chasing super vision Daniel Durrie, MD, recently studied a differ- ent refractive approach, topography-guided LASIK. 2 The study looked for trends in the data from the FDA clinical trial as well as data culled from the original trial sites. "The one thing that Examining the latest research in corneal refractive surgery About the doctors Jorge Alio, MD, PhD Professor and chairman of ophthalmology University of Alicante Alicante, Spain Marcus Ang, MBBS, PhD Associate professor of ophthalmology Duke-National University of Singapore Singapore Daniel Durrie, MD Clinical professor of ophthalmology University of Kansas Medical Center Kansas City, Kansas David TC Lin, MD Clinical associate professor of ophthalmology University of British Columbia Vancouver, Canada RESEARCH HIGHLIGHT

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